Emerging technologies and new instruments entering the modern clinical lab mean existing training plans may need periodic changes. Five “rules” can help managers and trainers write effective learning objectives and training plans. Stephen Covey states in Seven Habits of Highly Successful People that it is usually wise to begin with the end in mind. The first step is to write down measurable learning objectives (outcomes), describing clearly and in detail what a trainee should know or be able to do at the end of training. For example, “calibrate the Acme hematology analyzer,” “perform an infant heel capillary puncture for bilirubin,” or “explain the importance of medical ethics as it relates to lab testing.” Note the lack of ambiguity in these expectations; well-written learning objectives simply describe what is expected of a trainee; they do not describe a trainer’s behavior — like “teach capillary puncture,” “give out the panic values for electrolytes” — teaching activities should not be part of learning objectives. As an integral part of the training plan, however, activities do provide specific guidance for a trainer. To deal with different types of activity, three categories of learning objectives exist:
- Cognitive (knowledge) describe what the trainee must know at the end of training.
- Psychomotor (skill) describe a skill or activity the trainee must be able to demonstrate at the end of training.
- Affective describe a feeling or attitude that a trainee must develop during training1 — pride in workplace, team, and/or strong work ethic — and appear in new-employee orientation. Training programs focus on technical knowledge and skills.
Rule 1. Write good learning objectives.What is the training session’s goal? What is expected of a trainee after training? Put objectives in logical order: knowledge should be taught before skill. Knowing how the Acme hematology analyzer works should be covered before the trainee learns to operate the instrument. In knowledge objectives, the clearly stated behavior is the activity, and the object is what will receive that behavior (e.g., “recite” is the behavior, while “the panic values for electrolytes” is the object and answers the question “recite what?”). Note: This is a “knowledge” objective in that no physical activity or skill is required. If the knowledge objective can be envisioned as a written-test question, it is a properly written learning objective.
Psychomotor (skill) learning objectives have three parts: condition, behavior, and standard. The condition states with what equipment or under what conditions the behavior will take place. If the entire skill objective is: “Given unknown whole blood samples, one set of typing reagents, a serofuge, and an agglutination viewer, grade agglutination reactions to 100% accuracy using AABB standards for grading reactions,” the breakdown would be:
- the condition: “Given unknown whole blood samples, one set of typing reagents, a serofuge, and an agglutination viewer … .”
- the behavior is: “…grade agglutination reactions … .”
- then, the standard — which describes the minimum performance standard to demonstrate adequate learning has taken place — would be: “… to 100% accuracy using AABB standards for grading reactions.”
Incorrect methods or procedures are never are presented as objectives. Knowledge objectives can be written on different intellectual levels, depending on what is most useful to a trainee and to the educational objective. If a trainee is expected to interpret data or to solve complex problems, objectives that require only rote memorization may be inadequate. Examples of ways to sort the level of intellect and skill inherent in a learning objective are contained in Bloom’s Taxonomy, Gagne categories, and the Quellmalz framework. Most board exams simplify and combine these intellectual levels into three broad categories:
- Recall — reciting or explaining a concept. Useful verbs at this level are recite, recall, identify, match, list, recognize (e.g., “List the frequency of each ABO blood type in the U.S.”).
- Interpretation — interpreting information, test results, or patient data. Verbs include discuss, compare, contrast, describe, interpret, and explain (e.g.,”Compare and contrast the development of an autoantibody and an alloantibody.”).
- Problem solving — arriving at a solution to a situation or problem. Verbs include develop, organize, solve, and discuss (e.g., “Given the percentage of fetal cells in a mother’s circulation using Kleihauer Betke stain, solve for the number of vials of Rh immune globulin to be administered to the mother.”)
Knowledge verbs/phrases to avoid are “know something about,” “have a rough idea about,” “gain an appreciation for,” “learn about,” “get a feel for,” “get an idea about,” and “understand.” Imprecise terms are hard to measure and, thus, do not make good test questions. “Gain an appreciation for drawing blood cultures” cannot be objectively measured; “List the steps in drawing blood cultures” is a more coherent test question.
Skill objectives simply list the behavior or verb that describes the expected activity: calibrate, calculate, bend, read, analyze, clean, measure, dilute, disassemble, combine, assess, and repair. “Given the Acme hematology analyzer, three levels of calibrators, and the calibration SOP, calibrate the instrument in accordance with Calibration SOP 27.9.”
Continually review learning objectives to ensure compliance with academic, institutional, and regulatory requirements. Leave out superfluous objectives that will not directly contribute to the learning experience. The story of the first attempt to vaccinate a child against rabies may be fascinating, but it is not relevant to the task of performing a rabies antibody titer on human serum.
Rule 2: Evaluate each learning objective; decide how it can be supported by using different training methods. Learning objectives serve as definitive guides in preparing training plans. Each plan should be kept as an official record. A new version of a training plan suggests the old one be kept on file if needed for inspection. Does the objective require knowledge? Mix up instruction methods to generate and maintain interest in a subject. Look at available resources before developing a training plan. Lectures, DVDs, or video instruction, online learning modules, reading and/or research assignments, guest speakers, classroom discussion of case studies, handouts, charts, and knowledge games all support a knowledge learning objective. Instructional material must support learning objectives: write an objective, then list educational-support activities and/or instructions for the trainer directly below it.
Sample Training Plan – Unit of Instruction
Skill objectives require hands-on demonstration and instruction; resources — analyzers, reagents, diluents, and pipettes — must be available to complete those. Instructional content is usually the standard operating procedure (SOP) related to the skill objectives. Equipment — plastic arms for phlebotomy training or outdated reagents for practice — may be dedicated to training only. Developing skills takes time, so ensure trainees have ample time to practice. Group all skill-training activities under each skill-learning objective — and the training plan is written.
Rule 3: Measure knowledge and skill to ensure the training program is effective. The true value of any training program is measured by how much trainees learned through their regular written or oral testing, or by a trainer’s observational assessment of their development as they perform the skill while being graded against a performance checklist, competency-assessment checklist, or an SOP. (Competency assessments [skill tests] demonstrate and document that a trainee can perform a critical lab task without error or assistance. Labs sometimes require annual competency assessments — with two being completed in the first year of employment.) A minimum standard must be established for knowledge and skill performance. If a trainee cannot meet the minimum standard, remedial training or other remedies must be in place. All test knowledge questions and skill challenges should be derived from learning objectives. To ask a trainee questions on the historical development of the rabies vaccine when the learning objectives only require knowledge on performing the rabies antibody titer test would be inappropriate.
Rule 4: Keep accurate training records. In the clinical lab, keep an accurate training record for each trainee; training and training-record requirements are outlined by the Food and Drug Administration. For clinical labs that fall under the 1988 Clinical Laboratory Improvements Amendment, trainers are required to keep records of all training activities, plans, dates, test scores, and names of trainers and trainees. Also have a record of the trainer’s qualifications. An employee’s training record should be a master training checklist with each training section, trainer’s and trainee’s initials, and the completion date for each training section.2 Trainees should be tested for competency on each critical lab procedure after completing training for that procedure. Employees’ training records and competency assessments are often examined by auditors and inspectors to ensure the lab’s compliance with accrediting- and licensing-agency standards. Training and competency records (electronic [with a back-up system] or paper) should be well-organized for easy retrieval.
Rule 5: Look for improvement through feedback. Review a training program regularly. To objectively evaluate it, ask an employer if the trainee meets expectations. If a trainee is weak in a particular area, modifications to the training plan may be in order. Get feedback from trainees. What changes could create a better program? Was too much time spent on one area and not enough in another? How was their relationship with trainers? Select qualified, motivated, and skilled trainers. Good trainers are the “engines” that drive a quality training program; they should be organized, have good social skills and desire to train others. Good training programs require well-written training plans, enthusiastic, qualified trainers, and eager trainees. Using these five rules for a standardized approach to develop a lab-employee or lab-science student training program can take confusion and uncertainty out of what may once have been time-consuming and difficult.
Thomas L. Patterson, MS, MT(ASCP), assistant professor, and Rodney E. Rohde, PhD, SV, SM, MB(ASCP)CM, associate professor, teach within the Clinical Laboratory Science Program at Texas State University-San Marcos, TX. This article is based on the authors’ original paper presented at the Texas Association of Clinical Laboratory Scientists, April 17, 2010, in El Paso, TX.
- Gronlund N. How to Write and Use Instructional Objectives. Englewood Cliffs, NJ: Merrill Publishing; 1995.
- U.S. Food and Drug Administration. Science & Research. Vol. II – Personnel: Training Procedure ORA-LAB.5.2. Revised 2010. U.S. Food and Drug Administration.